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36 Cards in this Set
- Front
- Back
SPI syndromes
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concussion
incomplete complete |
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Complete SCI
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no sensory or voluntary motor fxn below level of injury
intact BC reflex <5% chance recovery |
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Incomplete SCI
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some neuro fxn below injury level
intact BC reflex (5 ex. syndromes seen later) |
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Mech of INjury
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Primary: Contusion, Compression, Stretch, Laceration
Secondary: ischemia, edema (accompanies all SCI 2ndary to vasc disruption and vasoactive subs) |
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Axial loading
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spinal compression, force transmitted via scolumn, like hit to top of head diving
mech: narrowing of IV spaces shifts IV discs fractures |
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Subluxation
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incomplete dislocation, still articular continuity
25% involve 1 facet >50% involve 2 facets=complete dislocation! mech: any direction of force-w/head flexed, hangman's |
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Hangman's Fracture ("Tip")
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C2 fx/ subluxation/ dislocation on C3=death
(vs. C5 on C6 snaps neck) |
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Occipitoatlantal dislocation
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Fatal
neuro deficit c1 flacid quadriplegia needs rigid immobilization |
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Jefferson Fx
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Bust fx of c1 atlas ring
caused by ax-loading on head multiple fxs of ring no cord compression- safe 4 mo immobilized |
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C1-C2 dislocation
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w.out fx: odontoid failed
w. fx: odontoid less likely assoc with severe neuro inj immob until odontoid healed |
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odontoid fx
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c2
type I-III, III=unstable with lots of front/back motion causing compression |
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Unstable Axial Compression Fx
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Principle of ring: can't break just one side!
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Clay Shoveler fx
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ripped section of spinous process
no neuro deficit |
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hangman's fracture
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lethal
cord completely crushed bilat fx of post arch of s2 spondylolysis hyperextension |
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chance fx
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horizontal fx through vertebra
severe crush area sags down bleeding and inj to sc |
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Laminectomy
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decompression of sc
indications: - Quickenstedt test (blocked flow of CSF when pressure applied) bony fragments in scanal acute ant scord syndrome Contraindications: acute ant cervical scord synd, recovers, met/pulm complications, other severe inj req sx |
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Transection cord injury
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partial/complete severing of scord
complete: cervical spine:quadriplegia, incont, resp paralysis <T1: incont, paraplegia |
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Rectal Exam
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Bulbocaverosus reflex-anal sphincter contraction/wink
involved S1-3 nerve roots and reflex arch absense of reflex=continuation of spinal shock us resolves in 48 hrs and BC returns |
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Cauda Equina Synd
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incomplete SCI
Herniated L2 crushes spinal cord no BC reflex inj to lumbosacral roots sensorymotor & bowel/ bladder deficits |
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Conus Medullaris Synd (S3-5)
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incomplete SCI
L1 burst inj persistent loss of BC reflex saddle anesthesia sphincter loss intact LE motor/sensory |
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Central Cord Synd.
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incomplete SCI
hyperextension, tumor paresis/plegia of arms>legs post column spared more sensation in upper ext sacral sparing good prognosis |
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Ant Cervical Cord Synd
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incomplete SCI
hyperflexion motor, pain, temp loss dorsal column preserved autonomic dysfunction sacral sparing 50% recovery |
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Ant Spinal Cord Infarction
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incomplete SCI
common ant and thoracic acute paralysis below lesion dissociated sensory loss (pain/temp) post column fxn remains loss of sphincter fxn Brown-sequard may occur |
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Brown-Sequard
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incomplete SCI
penetrating trauma (tumor, etc) IPSILATERAL:motor paralysis, loss of touch/proprio below lesion, hyperanesthesia CONTRALATERAL pain/temp loss 1 or 2 seg below lesion |
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Nerve Root LEsion
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isolated, at any level
partial or complete radicular pain sensory dysfunction weakness hyporeflexia or areflexia |
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Steroids
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to manage SCI
reduce body response to inj reduce swelling and cord pressure administer within 8hrs 1.Methylprednisolone - Solu-medrol 2.Dexamethasone- decadron or hexadrol (more potent than #1) both lessen cap dilation and permeability |
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Managing SCI
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Body spica (w/mobility)
Knight-taylor brace Surgical fixation |
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Pediatric spine
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up to 10:epiph growth
over 10: adult |
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Atlantooccipital (ped)
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rare
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atlantoaxial (ped)
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trauamatic lig disruption
lig laxity rel to local inflamm rotary reformity odontoid separation pain, no neuro def, translation of C1 on C2 by forward slip |
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Atlantoaxial Rotatory Displacement (ped)
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common cause of TORTICOLLISIS
cause unknown spontaneous onset w/URI Sternocleidomastoid:neck spasms, head tilted to affected side, rotated to opp side w/slight flexion |
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Odontoid Fx (ped)
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epiphys slip
flexed head with acute trauma(drop kid on head) |
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Schuermann's Disease
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(peds!)
THORACIC KYPHOSIS wedge of 5 adj vertebra=dorsal hump end plate irregularity, disc space narrowing can be hereditary inhibition of growing, wedging better by forward flexing, releved by rest |
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traumatic SPONDYLOLYSIS
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ped- MC at L5-S1
congenital or microtrauma to growth plate lower back pain in kids <10, familial aggravated by activity, better with rest no nreve root compression hamstring tightness PARS INTERARTICULARIS defect: Scotty dog sign neck failed to unite/broken to allows slipage of L5 on S1 feels better to lean forward |
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SPONDYLOLYSTHESIS
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ped spondylolysis that slips
grades 1-3 (3=severe) onset teen/elderly microtrauma increased lordosis (big butt) L4 slips on L5, pain worse with sitting |
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Sculiosis
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25deg:Brace
>45deg:Sx |